Relapse prevention is like a tree with multiple roots: biological, psychological, social and spiritual.

Biological factors can include maintenance therapies, such as methadone or buprenorphine for opiate dependence. Naltrexone or acamprosate may be utilized similarly in the context of alcohol dependence.

Additional pharmacotherapies may be indicated for the treatment of co-occurring psychiatric conditions. Underlying mood or anxiety disorders may have driven a person into drug or alcohol abuse and dependence. In such a situation, effective pharmacologic treatment of the underlying disorder may be essential for maintenance of recovery.

Finally, a healthy lifestyle is the foundation for relapse prevention. Sufficient sleep, good nutrition and regular physical activity are all integral components of a healthy lifestyle. Vigorous physical activity increases the synthesis and release of endorphins in the brain. Endorphins are our own natural opioids. Among their many functions, endorphins inhibit the activity of the hypothalamic-pituitary-adrenal (HPA) axis. The effects of this inhibition include the experience of calmness and cheerfulness.

Psychological, social and spiritual development are additional essential facets of relapse prevention. Psychotherapy may be helpful in addressing underlying issues such as low self esteem and family of origin dynamics. Healing the wounds of early life trauma is absolutely essential for relapse prevention.

Psychotherapy can be a powerful complement to 12 step work. In particular, psychotherapy may be necessary for accomplishing the fourth step (making a searching and fearless moral inventory of ourselves).

Among the multiple human shadow attributes, narcissism is a potential core threat to recovery. Humility is the basis for recovery. Arrogance paves the way for relapse.

Social and spiritual dimensions of relapse prevention can offer antidotes to arrogance. Humility, compassion and a moment to moment awareness of our interdependence are all vital for maintaining recovery. As Santideva, an eminent 8th century Buddhist scholar, wrote:


No man is an island. Relapse prevention hinges on a commitment to a cause larger than oneself.